Trust is an important indicator of the quality and performance of healthcare systems and individual care professionals. More than half of PaRIS respondents trust the healthcare system in their country. This chapter explores empirical findings and relationships related to trust from PaRIS data linking trust related outcomes to physical and mental health, experiences of care, healthcare capabilities, individual characteristics, and primary care characteristics. Overall, higher levels of trust are associated with better health, better experiences of care, care co‑ordination, and better capacity for self-management. The chapter concludes by discussing policies that and investments that can be implemented to build higher levels of trust in healthcare systems and care professionals.
Does Healthcare Deliver?
Abstract
What PaRIS data tell us about trust
People living with chronic health conditions often depend heavily on healthcare systems to deliver their care or to provide support for managing their conditions. In the context of this relationship, many people living with chronic health conditions may have limited ability to individually verify the quality of the services they receive. This makes trust, built over time, essential for ensuring confidence in the healthcare system.
More than half of the PaRIS respondents trust their country’s healthcare system. However, trust levels vary significantly across countries. In Spain1, Saudi Arabia, Norway, the Netherlands, Switzerland and Belgium, over 70% of respondents expressed trust in the healthcare system, while in Wales (United Kingdom) and Greece, trust fell below 50%.
People are more likely to trust the individual healthcare professionals than the broader system. Almost four‑of-five patients living with chronic health conditions had high trust in the last care professional they saw.
Trust in the healthcare system goes hand in hand with better health. Patients who report high levels of general health are almost 20% more likely to trust the health system than those who report poor health (66 and 56% of each group trust the healthcare system, respectively). Likewise, the average mental health scores of those who trust the health system are 6% higher than those who do not.
The connection between the individual experience of high-quality care and trust is evident. Patient perceptions of high-quality care, having a central point of contact for health problems, having longer relationships with care professionals, and seeing care professionals that schedule longer appointments all positively impact trust across countries.
People who felt that their primary care professional spent enough time with them are almost 90% more likely to trust the healthcare system compared to those who did not feel this was the case (64% compared to 34%). Likewise, people who feel like their care professional encourages them to raise concerns are 25% more likely to trust their healthcare professional than people who are not encouraged (90% compared to 71%).Policies to promote patient safety, better care co‑ordination and continuity, and sufficiently long, higher-quality care interactions can result in outcomes that influence higher levels of trust for people living with chronic health conditions.
Seven percent of PaRIS respondents living with chronic conditions reported that their last consultation took place virtually (over the telephone or video consultation), as opposed to face‑to-face visits with care healthcare professionals (either in the office or at home). Virtual care services are not necessarily less trustworthy than other, more “traditional” forms of care. People who used virtual care were often just as likely to trust the healthcare professional they saw as those who received face‑to-face care in more than two‑thirds of the PaRIS participating countries. Similarly, PaRIS patient respondents who report using at least one online service offered by their healthcare professional, such as booking appointments online, ordering repeat prescriptions online, accessing their medical records online, or video consultations are just as likely to trust the healthcare system as those who do not.
As patients gain confidence in managing their own conditions, they engage more actively in their care and may view the healthcare system more as a partner in achieving better health. Supporting patients in self-managing their conditions helps lay the foundation for trust. Countries with higher percentages of patients with high confidence in self-management of their chronic conditions were more likely to also have higher levels of trust in healthcare systems.
Can patients trust that their healthcare professional is acting in their best interest? Do they think their healthcare professionals will use the latest evidence and will provide good care? Are primary care practices safe places to seek care? These are real questions many people face as they consider their interaction with their primary care practice and the healthcare system more broadly.
6.1.1. More than half of the patients in PaRIS trust the healthcare system in their country
Trust in healthcare systems is essential for their function. Efforts to promote trust have impacts from the micro (individual) to the macro (system) level. Public trust in health systems and healthcare professionals is essential for delivering quality care, as it influences how people access services, use them, and adhere to medical advice. The other way around, the consistent, responsive delivery of high-quality care enforces and builds population trust. At the individual level, trust contributes to improved outcomes and experiences (and vice‑versa). At the system-level, trust is needed to improve health system resilience and to facilitate whole‑of-society responses when needed (OECD, 2023[1]). Trust can be easily eroded by low-quality care, poor communication, and a lack of continuity of care. Healthcare systems and individual healthcare professionals are required to constantly work to build a foundation for trust by providing high quality, patient-centred care, and maintain it over time.
The concept of trust refers to the idea that a person’s belief that another person or institution will act consistently with their expectations of positive behaviour, even in cases when the outcomes – or the actions to produce them – cannot be verified (McKee and Greenley, 2023[2]; OECD, 2017[3]).
PaRIS asks patients to assess their level of trust in their country’s healthcare systems as well as their trust in the last healthcare professional they saw. Those that trust the healthcare system have indicated the responses “agree” or “strongly agree” to the question “How strongly do you agree or disagree that the healthcare system can be trusted?” Those who trust their most recent healthcare professional indicated the response “yes, definitely” to the question “Did you have confidence and trust in the healthcare professional you saw or spoke to?” when referring to their most recent consultation with a primary care professional (a doctor, nurse or other healthcare professional), unless otherwise indicated in the analysis.
For the purposes of this chapter, trust in healthcare systems and the care professional are discussed together, even though the construct of the items and analysis of the response categories differs. This is a limitation of the analysis, in addition to the reliance on the two items that directly capture trust. Trust is a multidimensional and nuanced construct that can also be more comprehensively assessed through a broader assessment of related domains (Meyer et al., 2024[4]; Aboueid et al., 2023[5]). In Spain, the question on trust in the healthcare system relates to trust in the primary care professionals within people's primary care practice. This variation might influence trust levels in Spain and limit comparability with other countries that refer to trust in the healthcare system more broadly.
See the PaRIS webpage for the questionnaires, https://www.oecd.org/content/dam/oecd/en/about/programmes/patient-reported-indicator-surveys/PaRIS%20patient%20questionnaire.pdf, and more on the methodology in Chapter 7.
Note: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older.
Source: OECD PaRIS 2024 Database.
Trust in healthcare takes place at two main levels, the first being institutional trust (i.e. the trust in healthcare systems and health supporting institutions) and social trust, which relates to trust in individuals such as healthcare personnel (i.e. the trust a person has in their regular doctor). The OECD has a long history in assessing the former, and has developed a trust framework that identifies drivers for trust in public governance, such as reliability, responsiveness, openness, integrity, and fairness (Brezzi et al., 2021[6]).
On average, 62% of all PaRIS respondents living with one or more chronic health condition trust the healthcare system (Figure 6.1). Trust in healthcare systems varies considerably across countries, with patients indicating they trust their healthcare systems surpassing 70% in Spain1, Saudi Arabia, Norway, the Netherlands, Switzerland and Belgium, and remaining below 50% in Wales and Greece. Country trust levels among the PaRIS population are relatively concurrent with findings assessing population level satisfaction with healthcare systems. Population level indicators captured via the OECD Drivers of Trust in Public Institutions Survey similarly shows satisfaction with health services among people with recent contact with the health system as being above the OECD average in Belgium, Luxembourg, the Netherlands, Norway, Spain and Switzerland, with satisfaction levels below the average in Greece, Portugal and the United Kingdom (OECD, 2024[7]). Distrust among PaRIS respondents (those who disagreed or strongly disagreed that the healthcare system can be trusted) was over 15% in Greece, Romania, Wales, Iceland and under 6% in Saudi Arabia, Spain, Czechia and Norway. On average almost one out of ten (9%) PaRIS respondents with chronic conditions do not trust the healthcare system.
On average, 78% of the patients with chronic health conditions indicated that trusted the last care professional they saw. This is 26% higher more than the percentage who trust the healthcare system (Figure 6.2.). More than 85% of PaRIS patients living with chronic health conditions trusted their most recent care professional in Switzerland, Belgium, the Netherlands and Canada. The lowest levels of trust in care professionals, below 70%, were observed in Spain and Greece. Additional discussion of country outcomes related to trust in health systems can be found in Chapter 2.
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older.
Source: OECD PaRIS 2024 Database.
Trust can then be examined in terms of its relationship to other domains addressed in PaRIS, namely 1) health outcomes, 2) experiences of care, 3) delivery system design, 4) individual and socio-demographic factors, and 5) individuals’ health and healthcare capabilities (see Figure 6.3). Each of these relationships is explored in a proceeding section of this chapter.
6.1.2. Trust in healthcare systems has a connection to trust in institutions more broadly
Trust in the health sector, like trust in government institutions overall, has experienced several challenges in recent years, notably those caused by the experience of the COVID‑19 pandemic and related response. According to data from the COVID‑19 Trends and Impact Survey, on average, only 37% of people in OECD countries said they trusted COVID‑19 information from government health officials in 2021 (de Bienassis et al., 2023[8]). The 2021 OECD Survey on Drivers of Trust in Public Institutions found that, on average across countries, under half of respondents had confidence in their government’s capacity to act to protect people’s lives in the event of a future pandemic (OECD, 2022[9]). Moreover, countries in which most people think their government learned from the pandemic are also the countries in which more people are likely to trust that government. Levels of trust can relate to meaningful population health outcomes; for example, countries where more people had trust in institutions and interpersonal trust had on average lower reported COVID‑19 and excess death rates during certain phases of the COVID‑19 pandemic (OECD, 2023[1]).
Results from the OECD Survey on Drivers of Trust in Public Institutions also showed that the share of respondents who were satisfied with the healthcare system decreased in 16 of 19 countries – dropping by 8 percentage points on average between 2021 and 2023, from 63% to 55% (OECD, 2024[7]). Trends declines in satisfaction with the healthcare system in most countries during post-COVID period have been at least partially attributed to a temporary bump in satisfaction during the COVID‑19 pandemic, but are also part of a longer-term trend.
As described in Chapter 2, variation in trust in healthcare systems is attributable to different factors – patient level factors accounting for 90% of variation, practice factors relating to 2% and country level factors accounting for 8%. National attitudes for trust in government and related institutions play a role, and findings from the PaRIS survey on trust in health systems are related to results from OECD Trust Survey (2023), which captures trust in public institutions (see Figure 6.4). Even so, most variation in performance is dominated by individual’s experiences and complemented by variation in practice characteristics – indicating opportunities for improvement and policy implementation for improving trust at each level of the system.
Note: Data from the OECD Trust in Public institutions relates within-country distributions of responses to the question “On a scale of 0 to 10, where 0 is not at all and 10 is completely, how much do you trust the national government?”. 6‑10 to “high or moderately high trust“. OECD Trust Survey Data is for the United Kingdom. Data from the OECD PaRIS: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions.
Source: OECD Trust Survey 2023 and OECD PaRIS 2024 Database.
Transparency and information integrity in the health sector
High levels of trust are particularly important in cases where there may be significant information asymmetry, i.e. there are differences in parties’ access to or understanding of relevant information. This is the case in healthcare, where professionals traditionally have more information about the presence and severity of health conditions and the options for treatment than patients; patients typically rely on healthcare professionals for their expert options and guidance. Even so, recent trends in the health sector have reduced this asymmetry of knowledge by increasing health literacy, improving access to individuals’ health information through improved information infrastructure, improved transparency about data collection and use, and policies to support shared decision making and patient involvement in care plans. In cases where patients rely on the expert opinions of healthcare professionals, they should feel confident to trust their care professional, calling on trust built from an ongoing, transparent, and respectful relationship.
The risks of disinformation in healthcare are rapidly evolving and can have a corrosive effect on trust. Information environments in which citizens do not trust the information they receive or in which they are inundated with false and misleading content on online information platforms can lead to the spread of misinformation or public health conspiracy theories, for example those relating to vaccination or use of unapproved treatments (OECD, 2024[10]). Mis- and disinformation can contribute to polarised societies and undermine trust in public institutions at large, including healthcare systems.2
Lack of clear messaging, information and timely data can lead to diminished levels of trust in the population. This includes poor communication resulting from too much information – both proven and unsubstantiated – during times of crisis.3 Specific to the health sector, the recent COVID‑19 pandemic triggered widespread mis- and disinformation that undermined both understanding and acceptance of science and public health policy (de Figueiredo et al., 2020[11]) Despite widespread recognition among experts that COVID‑19 vaccination can reduce the occurrence of serious COVID‑19 related complications, significant portions of the population were unwilling to be vaccinated – in part due to misinformation (OECD, 2021[12]). Disinformation continues to impact prevention such as vaccination and chronic disease management.
As a counter to these threats, clear and transparent communication is a critical component of care relationships – and is seen as core function of most ministries of health (OECD, 2021[13]). Communication is essential for coherent messaging both internally and externally and empowers individuals to understand and act on health related information.
An individual’s trust in their healthcare professional can impact their health. Better health outcomes can likewise be associated with higher trust in the healthcare system because people who are healthier may have received better care, or at least feel that they receive better care, and therefore have higher trust. Moreover, high performing healthcare systems with strong primary care are those that are successful in 1) improving health outcomes for people living with chronic health conditions and 2) have cultivated high levels of trust among this same group.
There have been numerous research studies establishing the relationship between trust and health outcomes, and in particular subjective health outcomes (Birkhäuer et al., 2017[14]). Trust in government and healthcare system competency can lead to improved compliance with advice from healthcare professionals. Survey research conducted in 2020 across 23 countries, for example, found that higher trust in government competency to handle the pandemic was significantly associated with increased adoption of health behaviours (handwashing, avoiding crowded spaces, self-quarantine) (Han et al., 2023[15]).
Results from PaRIS show that people who rate their general health as good, very good, or excellent are more likely to trust the healthcare system (66% on average) as compared to those who rate their health as poor or fair (56%) – a 10 percentage point difference (see Figure 6.5). Results are similar to those who trust their most recent care professional. Eighty-one percent of people in better health trust their care professional, compared to only 73% of those who assess themselves as being in poor or fair health. Trust does not seem to be significantly related to the number of chronic conditions a person is living with – and results are comparable across people with no, one, or two chronic health conditions (Figure 6.6). People with three or more chronic conditions tend to have slightly lower levels of trust, but differences are not statistically significant (See Chapter 3 for additional discussion of multimorbidity and other PROMs and PREMs).
Average trust in the healthcare system and most recent healthcare professional according to assessed level of general health
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05), except for France, Greece, Romania, Saudi Arabia, the United States and Wales. All differences for Trust in the healthcare professional are statistically significant (p<0.05), except for Greece, Portugal, Spain and the United States.
Source: OECD PaRIS 2024 Database.
Percentage of people who trust in healthcare system based on a person’s number of chronic health conditions (CCs)
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Data based on PaRIS19 Participating Countries. Error bars show the range of the comparative interval.
Source: OECD PaRIS 2024 Database.
People with the highest levels of trust in their care professional also have higher average PROMIS mental health scores4 than those who do not (47.6, compared to 44.8) (Figure 6.1). People with good mental health may have more trust in the healthcare system because they are more likely to feel that health professionals and institutions are responsive to their needs, which reinforces positive experiences and further strengthening care related relationships. Conversely, previous analysis from the OECD shows that people living with mental health conditions are more likely to have received conflicting information from healthcare professionals (OECD, 2019[16]) and analysis from the PaRIS survey finds that that among people living multiple chronic health conditions, people have worse experiences of care co‑ordination if one of their conditions is a mental health condition, as compared to others without any mental health condition (see Chapter 3).
Note: PROMIS® Scale v1.2 – Global Health component for mental health is a T-score metric with a range of 21‑68, and a good-fair cutoff of 40, higher values represent better mental health. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely; Yes, to some extent” versus “No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
People’s experiences with public services influences how they perceive their governments, and public satisfaction with administrative and social services is an important driver of trust. The 2021 OECD Survey on Drivers of Trust in Public Institutions demonstrated that a single standard deviation increase in users’ satisfaction with services was associated with a 4 percentage point increase in trust in national government, and a 6 percentage point increase in the levels of trust in the civil service (Brezzi et al., 2021[6]).
Trust and experience of healthcare are strongly intertwined, as trust can impact how perceives their relationship with their care professional and is based on the perceived quality of care received in the past. Having a foundation of trust may also improve the experience of care and lead to more generous assessments of current care, based on previous satisfaction with services. Findings from across countries show that the relationship is profound. PaRIS respondents with chronic health conditions tend to trust the health system when they rate their experience of quality of primary care overall more highly (see Figure 6.8). On average, across countries, people who rated experienced quality of primary care over the last year as excellent or (very) good were 35 percentage points more likely to trust the healthcare system than those who indicated lower levels of quality of care over the last year – with a 43 percentage point difference in regard to the healthcare professional. This trend persists to the macro-level, where countries with higher averages on the person-centred care (measured with the P3CEQ scale, see Chapter 4, Box 4.2) are also more likely to have trust in healthcare systems among PaRIS respondents (see Figure 6.9).
Average percentage of people who trust in the healthcare system and their healthcare professional according to how they rated the medical care that they have received in the past 12 months from their primary care practice
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05). All differences for Trust in the healthcare professional are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
Note: Person-centred care: P3CEQ Questionnaire. Response to eight questions measuring if care is person-centred. Scale ranges from 0 to 24, higher scores represent better person-centred care. Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older.
Source: OECD PaRIS 2024 Database.
The experience of adverse events or harm over the course of care can reduce trust in the healthcare system. On average, across countries, 30% of PaRIS respondents reported experiencing a harm or patient safety event over the course of their care. PaRIS shows that that people who have experienced an event or circumstance that could potentially cause them harm in primary care – such as, not getting an appointment when needed, receiving a wrong or delayed diagnosis or treatment, or experiencing problems with communications between healthcare professionals – are 1.6 times less likely to trust the healthcare system than those who have not experienced such an adverse event (45% compared to 70%) (Figure 6.10). Likewise, trust in the person’s last care professional is 1.4 times lower among people who have experienced an adverse event compared to those who have not (59% compared to 85%). These findings demonstrate that experience of an adverse event has a strong impact on deteriorating trust for both the professional and the healthcare system more broadly.
“I’m afraid I don’t have much trust in the public system. It has failed me on several occasions. The most recent was a misdiagnosis of sepsis. I was sent home after being told I had a virus. I couldn’t walk and thought I was dying. Luckily, my husband wasn’t satisfied and took me to our GP, who had admitting rights at a private hospital. Thank goodness I have private health insurance. I was in that hospital for a month on IV antibiotics. I was very ill and didn’t remember much of the first week. I was diagnosed with sepsis and a massive spinal epidural abscess. My GP and the two doctors looking after me all told me on different occasions that had I gotten to the hospital 24 hours later; I would not have survived. I often wonder if it had been my husband presenting with the same symptoms, whether he would have been listened to more carefully and been admitted. I was fobbed off with the words, “There is nothing major wrong with you. Take some Panadol, and you will be fine”. I am so glad my husband had the presence of mind to take me to the GP.”
llyn, living with chronic lung conditions, rheumatoid arthritis, osteoarthritis and post-sepsis syndrome
Note: Examples of adverse events include not getting an appointment when needed, receiving a wrong or delayed diagnosis or treatment, or experiencing problems with communications between healthcare professionals. Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05). All differences for Trust in the healthcare professional are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
High quality care co‑ordination is an essential component of high-quality care, and the lack of co‑ordination undermines trust in healthcare and healthcare professionals. Needing to repeat healthcare information that should be in a person’s care record during a visit, for example, indicates poor care integration, inadequate data infrastructure, poor data capture processes, and poor capacity to facilitate care transitions. This has a fundamental impact on levels of trust. Overall, patients who needed to repeat health information that should have been in their care record were 32% less likely to trust the health system overall and 31% less likely to trust their care professional in average reported higher trust in the healthcare system compared to those who did not need to repeat information (51% compared to 68% for trust in the healthcare system, and 64% compared to 84% for trust in the healthcare professional) (see Figure 6.11). Despite the root causes of having to repeat information likely being caused by system related factors (such as lack of or poor-quality data infrastructure or poor care co‑ordination), the relationship between this experience and trust in the care professional is still substantial. In Norway, Wales and Slovenia, 40% fewer people trusted in the healthcare professional if people experienced the need to repeat information that should have been in the care record.
“The key factors that influence my trust are: the difficulty of access to specialized doctors, the difficulty of buying my medication, [and] the insecurity I face every time I talk with the doctor – if I fully understand everything he says to me.”
Zoe, 67 years old, divorced woman with severe osteoporosis, asthma and Paget disease
Average percentage of respondents who trust in the healthcare system and their healthcare professional according to the experience of needing to repeat health information
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05), except for Greece, Romania, Saudi Arabia and the United States. All differences for Trust in the healthcare professional are statistically significant (p<0.05), except for Saudi Arabia.
Source: OECD PaRIS 2024 Database.
The gap in trust levels between people who felt that their care professional spent enough time with them and those that did not is substantial – differing by 30 percentage points across PaRIS participating countries in regard to trust in the healthcare system and by almost 65 percentage points in regard to trust in the healthcare professional (see Figure 6.12). In the Netherlands and Italy, the gap in trust in the most recent care professional among those who did – and did not – feel that person spent enough time with them, exceeded 70 percentage points. However, across PaRIS participating countries relatively few – approximately 7% – respondents felt negatively regarding the amount of time spent with them by care professionals.
Average percentage of respondents who trust in the healthcare system and their healthcare professional according to the experience of having their healthcare professional spend enough time them
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05). All differences for Trust in the healthcare professional are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
Clear, sufficient communication is key to trust – and the receipt of sufficient health information is another metric that can be used to assess the quality and scope of communication. In response to the survey question, “To what extent do you receive useful information at the time you need it to help you manage your health and well-being?” only 1% of all PaRIS patients reported that they received too much information. An additional 40% of all respondents reported not receiving enough information. Receiving too little information for self-management corresponded to an average of 23% lower trust among PaRIS respondents (Figure 6.13), while those who received too much information generally still had comparable outcomes on trust to those who had received enough information (though the confidence intervals for the former group were large due to small sample sizes).
“A negative experience occurred when I visited a specialist who rushed through the appointment without addressing my questions about my treatment options. I left feeling dismissed and frustrated, which eroded my trust in that provider. This experience highlighted the importance of clear communication and patient engagement in building trust. Overall, positive interactions reinforce my confidence in the healthcare system, while negative ones remind me of the vulnerabilities patients face. He never looked at me, his eyes were on the computer …. Typing!”
Betsy, 68 years old, female, living with multiple chronic conditions, including obesity
Average percentage of respondents who trust in the healthcare system according to how much information they receive for self-management
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. Differences between enough information and not enough information are statistically significant (p<0.05) for all countries.
Source: OECD PaRIS 2024 Database.
Finally, the time a person waits for an appointment can impact care – leading to potential deterioration of a person’s condition in some cases or undermining confidence in the system’s ability to provide timely care. Results show that experiencing a problematic wait for the primary care appointment is associated with a 20 percentage point decrease of people trusting in the healthcare system and with a 25 percentage point decrease in trust in the care professional (Figure 6.14).5 This trend is consistent across all PaRIS participating countries, ranging from a 12 percentage point difference in trust in healthcare systems between these two groups in Saudi Arabia, to a 23 percentage point difference in Czechia.
Average percentage of respondents who trust in the healthcare system and their professional according to the experience of having experienced problematic waiting times
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05). All differences for Trust in the healthcare professional are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
An ongoing, trusting relationship between healthcare professionals and patients has shown demonstrable value to primary care. Relationships in primary care are, in part, contingent on the individual provider or providers, but also the overall structure of the primary care delivery system, which may be more or less conductive to building trusting relationships. PaRIS provides insight as to how the design of the healthcare system relates to trust through data generated by both the primary care practice and patient questionnaires.
6.4.1. Who provides primary care matters to patients
The type of care professional may influence trust through various mechanisms. Some people may feel most comfortable with being cared for by a medical doctor and feel confident in their qualifications. Others may feel more comfortable when seeing a nurse or nurse practitioner, trusting their concerns are well understood and that their care professional may have more time for them. A number of OECD countries have implemented reforms in recent years to expand the roles of nurses in primary care (Maier, Aiken and Busse, 2017[17]; Brownwood and Lafortune, 2024[18]).
Finding from PaRIS show that people who have a primary point of contact who is a doctor are 6 percentage points more likely to trust the system than those who have another type of point of contact (such as nurse, nurse practitioner, or other specialist) and 10 percentage points more likely to trust the healthcare system than those who have no primary point of contact at all (Figure 6.15). Overall, 78% of the patients report having a doctor as the single professional they usually go to for most of their health problems, while only 4% see another type of care professional, and 18% don’t have a single professional they go to for most of their care.
Average percentage of people with trust in the healthcare system based on the type of their primary point of contact in the healthcare system
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Primary care professional (PCP). Error bars show the range of the comparative interval. Data based on PaRIS19 Participating Countries.
Source: OECD PaRIS 2024 Database.
Related to the type of care professional patients see, is the consistency of that care professional – that is, if they are able to see the same person for most of their health problems as opposed to seeing multiple care professionals. Patients who have a main point of contact in the healthcare system (i.e. someone that they go to for most of their health problems) trusted the healthcare system 64% of the time, compared to only 54% of people who did not have a central point of care. The difference is similar for trust in the healthcare professional, where 68% of people who did not have a single professional they saw for most problems also trusted their professional, while 81% of those who did have a central point of care had trust in their healthcare professional (see Figure 6.16). In Czechia, Portugal and Iceland, if a person has a single care professional, they visit with most of their care problems, they are more likely to trust the last person they saw by over 20 percentage points more compared to those who did not.
Average percentage of respondents who trust in the healthcare system according to the experience of having a single healthcare professional they see for most health problems
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05), except for Belgium, Canada, Czechia, France, Greece, Saudi Arabia, the United States and Wales. All differences for Trust in the healthcare professional are statistically significant (p<0.05), except for France, Spain and the United States.
Source: OECD PaRIS 2024 Database.
Primary care can be delivered in a multi-specialty group practice, a group practice where patients see a single named professional or where they see multiple professionals, or in solo practices where only one primary care professional is present. While having a familiar, individual professional may be one way to ensure that people have a central care professional – a team approach of professionals is also effective, and the distinction between trust levels among patients who visited practices that either share (group practices with a shared patient pool) or do not share (solo practice, group practices with provider specific patient lists) patients was negligible.
6.4.2. Digital health can be just as trustworthy as traditional care modalities
Faced with significant disruptions to in-person care caused by the COVID‑19 pandemic, governments moved quickly to promote and operationalise the use of remote care – a trend that has persisted in the years following (OECD, 2023[19]). Seven percent of PaRIS patients living with chronic conditions reported that their last consultation took place virtually (over the telephone or video consultation), as opposed to face‑to-face visits with care professionals (either in the office or at home).
Virtual care services are not necessarily less trustworthy than other, more “traditional” forms of care. Despite modest trends across countries favouring higher levels of trust among people who use face‑to-face services, findings were mostly non-significant (Figure 6.17). Even so, some countries show clearer trends favouring in-person care. In Luxembourg, Romania and Greece there is an over 8 percentage point difference in trust in the healthcare professional based on the format of the care provided.
Average percentage of respondents who trust their healthcare professional according to if the care was in person or provided virtually
Note: Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely” versus “Yes, to some extent, No, not really; No, definitely not”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”.*Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. Differences are not statistically significant (p<0.05) in all countries, except for Czechia, Luxembourg, Romania, Slovenia and Spain.
Source: OECD PaRIS 2024 Database.
Most PaRIS patients (71%) report that their healthcare professional offers at least one online service, such as booking appointments, ordering repeat prescriptions, accessing their medical records, or video consultations. The availability of these services does not appear to be a major driver of trust for health systems. Trust levels in both the healthcare system and healthcare professionals showed no notable differences based on whether primary care professionals offered patient-facing digital services, such as appointment booking or reminders for regular preventive or follow-up care (e.g. flu vaccine or Glycated Haemoglobin for diabetic patients).
“I feel lucky that I have found a doctor for my osteoporosis treatment that is taking care of me like a father. He gives me advice about how to handle my situation at home, he shares with me anything new that is coming up regarding my disease and he introduced me to other patients with the same diseases as me, to exchange experiences.”
Lucy, 55 years old, divorced woman with osteoporosis, Hashimoto/thyroid, hypertension
6.4.3. Timely and consistent care is pivotal
A longstanding relationship with a primary care professional increases trust and assessed quality of care. Building trust takes time, and when people do not trust their primary care professional or are unhappy with their care, they might switch to a different professional. A longstanding relationship helps create trust and open communication between patients and their primary care professionals and helps primary care professionals understand their patients’ medical history, lifestyle, and preferences, so they can provide better care.
There is a clear link between the length of the patient-professional relationship and levels of trust in care professionals. Trust is highest among patients who have been seeing their healthcare professional for 10 years or more and lowest among those with a relationship of less than a year6 (see .
Figure 6.18). This relationship is further explored in Chapter 3, which highlights that people living with two or more chronic conditions are more likely to rate the quality of their care positively if they have been seeing the same healthcare professional for an extended period, particularly more than five years.
The relation between trust and length of relationship works in two directions – not only is trust built over time, but people are also more likely to continue to see a professional who they trust. On average across PaRIS participating countries, people who have been seeing their primary care professional for more than a year are 25% more likely to trust their healthcare professional than those who have been seeing their care professional for less time and are 17% more likely to also trust the health system.7
Percentage of people trusting their healthcare professional based on the length of time they have been seeing their professional
Note: Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely; Yes, to some extent” versus “No, not really; No, definitely not”. Error bars show the range of the comparative interval. Data based on PaRIS19 Participating Countries.
Source: OECD PaRIS 2024 Database.
Responsive and timely access to care is associated with higher levels of trust in the health system. As discussed in previously in this section, patient experience of problematic waiting times or lack of sufficient time spent with the care professional can reduce levels of trust in healthcare systems and professionals. In addition, people who attend primary care clinics who schedule longer consultations with their patients (more than 15 minutes per routine appointment) are 12% more likely to trust their healthcare professional and 5% more likely to trust the healthcare system overall.7 Longer scheduled consultations also show favourable results for care quality. Chapter 3 shows that people living with multiple chronic conditions are more likely to experience good quality of care when they have longer consultations scheduled.
“Between birth and age 60 I had four GPs – for 30, 5, 10 and 15 years respectively. Since then I have seen upwards of 20 different GPs. Without full and accurate exchange of records this can mean that much time is taken with familiarisation, and errors can occur. In the past, because I had a personal relationship with the GP this was rare, but recently less so.”
Anonymous patient, over 75 years old, living with osteo‑arthritis, hypertension and benign prostate hyperpathia
The amount of time between booking and attending an appointment impacts trust, with shorter wait times leading to higher levels of trust. PaRIS survey show that 67% of people who had their appointment the same day or the following day after booking their appointment trusted the health system, as compared to only 58% of people whose appointment was more than a week after scheduling (see Figure 6.19).
Percentage of people trusting the healthcare system based on the length of time between booking their most recent primary care appointment and when the appointment actually took place
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Error bars show the range of the comparative interval. Data based on PaRIS19 Participating Countries.
Source: OECD PaRIS 2024 Database.
Social factors influence trust – and research has found that factors such as education and income are associated with higher levels of information seeking, confidence, and trust (Fareed et al., 2021[20]). Minoritised groups often show the lowest levels of trust in healthcare systems, with good reason. Systemic discrimination can contribute to poorer health outcomes, undermining trust in the intentions and competency of the healthcare systems (Berchet, Bijlholt and Ando, 2023[21]). Individual experiences of discrimination and care delivery not catered to individual needs can lead to a vicious cycle, where low levels of trust impact care utilisation, therefore further impacting health outcomes.
People with higher education often possess a better understanding of healthcare processes and have higher levels of health literacy and awareness of entitlements and healthcare related rights. Education may also empower people to navigate healthcare systems more effectively, fostering confidence and trust in the care they receive (OECD, 2019[22]). The gap between those in the highest education level and the lowest is 8 percentage points on average across PaRIS participating countries, with 67% and 59% trusting the health system on average in each group (see Figure 6.20). The trust differential between the highest and lowest educational groups was over 12 percentage points in Australia, Belgium, Czechia, Norway and Portugal. The reverse trend was reported In Romania and the United States, those with lower education level had higher levels of trust in the healthcare system than those who had received higher levels of education.
Percentage of respondents with one or more chronic condition in each education group reporting having trust in the healthcare system
Note: See Box 5.1 in Chapter 5 for more information on definitions for High, Medium, and Low education. Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. Gaps between high and low education groups statistically significant for Australia, Belgium, Canada, Czechia, Iceland, Italy, Norway and Portugal. (p<0.05).
Source: OECD PaRIS 2024 Database.
PaRIS data show that age and trust are related, increasing slightly as the age categories increase, with statistically significant differences between levels of trust among the oldest (75 years of age and more) and youngest (45‑55) age groups (Figure 6.21). In addition, people living in rural areas are 13% less likely to trust the health system and 4% less likely to trust their most recent care professional than others.7 Differences in trust levels between respondents based on citizenship or country of birth reveal nuanced findings, for example, levels of trust in the care professional are comparable for those with and without citizenship in their residing countries. Similarly, trust in health systems is not related with country of birth. Interestingly, citizenship does appear to have an impact on trust in health systems – citizens are 17% less likely to trust the health system compared to non-citizens. See Chapter 5 for additional discussion of inequalities based on social and demographic factors, including gender and income.
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Error bars show the range of the comparative interval. OECD17 data. Differences are between age 45‑54 and 75+ are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
The relationship between trust and healthcare capabilities is multifaceted. Those with high levels of trust may both feel more confident in their abilities to contribute to their own healthcare but may also feel more confident deferring to their care professional and following their advice. On the contrary, those with low levels of trust may feel the need to take a more active role in managing their health (as they do not necessarily trust the guidance offered by their care professionals), and as a result may be more engaged – though they may rely more on unverified sources of information. Ideally, trust and healthcare capabilities should increase in tandem, as a trusting relationship fosters the confidence for people to take an active role in their healthcare, knowing they are able to reach out to their care professionals for support when needed.
“My GP communicates very well with me, he shows empathy, understanding, and creates healthcare plans that are easy to follow. I trust his judgment and the rapport is built through [these] trustful healthcare arrangements.”
Lana, 45 years old, living with uncontrollable hypertension, pre‑diabetes, arthritis, chronic back, severe allergic rhinitis, and lived experience of mental health issues
People who feel more comfortable navigating the healthcare system and self-managing their health conditions are more likely to have trust in healthcare systems related to their increased control of the care process and its outcomes. Countries in which there are more people with chronic health conditions who trust the healthcare system also have higher levels confidence in self-management (see Figure 6.22).
Note: P3CEQ Questionnaire. Response to question: “How confident are you that you can manage your own health and well-being?”, “confident or very confident” versus “somewhat confident or not confident at all”. Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. * Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older.
Source: OECD PaRIS 2024 Database.
“Trust increases when [healthcare professionals] give me options, explain things, and allow me to understand the reasons behind my health conditions, symptoms, or the need for a treatment. When I am presented with options and given an active role, that is what builds my trust in the healthcare system.”
Lucía, 42 years old, female, living with multiple chronic conditions
Confidence in self-management relates to people’s comfort speaking with medical professionals, particularly when they may be raising concerns or questioning diagnoses or courses of treatment. Being able to raise concerns without fear of repercussions and negative reactions from care professionals is indicative of trusting relationships where a patients well-being comes first. People who are encouraged to raise concerns with their healthcare professional are, on average, 15 percentage points more likely to trust the healthcare system and 18 percentage points more likely to trust their healthcare professional as compared to those who do not feel encouraged to raise concerns (Figure 6.23).
Percentage of people living with chronic conditions who trust the healthcare system or their most recent care professional according to if they were encouraged to raise concerns with their professional
Note: Trust in healthcare system: Response to question: “How strongly do you agree or disagree that the healthcare system can be trusted?”, “strongly agree, agree” versus “neither agree nor disagree, disagree, strongly disagree”. Trust in healthcare professional: Response to question: “Did you have confidence and trust in the healthcare professional you saw or spoke to?”, “Yes, definitely;” versus “Yes, to some extent; No, not really; No, definitely not”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people of 65 years and older. All differences for Trust in the healthcare system are statistically significant (p<0.05), except for Czechia and the United States. All differences for Trust in the healthcare professional are statistically significant (p<0.05).
Source: OECD PaRIS 2024 Database.
Trust in healthcare systems and care professionals is an important outcome of healthcare systems. People living with chronic conditions often deeply depend on healthcare systems to deliver their care – and may have limited ability to individually verify the quality of the care they receive. This is why trust, built over time, is essential to ensure people’s confidence in the healthcare system and healthcare professional.
The findings from this chapter show that across PaRIS participating countries, trust – in addition to being an indicator of healthcare system performance on its own – dually reflects the quality and person-centredness of care provided to patients. In measuring and prioritising trust, healthcare systems can identify deficits, foster stronger patient-provider relationships, and enhance overall patient experience and outcomes. The capture and assessment of this data in the PaRIS survey is a key first step that should be integrated into the ongoing activities of learning healthcare systems.
A concerted effort is now needed to drive improvements in trust, built on transparency and accountability, national and practice level efforts to support continuous improvement and more patient-centred approaches in healthcare delivery. This form of system wide emphasis on trust supports and contributes to more resilient and effective healthcare systems.
6.7.1. The trade‑off between efficiency and high-quality patient and caregiver relationships may be a false dichotomy when it comes to patient trust
People living with chronic conditions use a significant proportion of health services – including time and resources to consult with (often multiple) healthcare professionals. This on-going relationship emphasises the importance of the trust in healthcare professionals and the systems they access and adhere for the management of their conditions. It creates an opportunity for front-line primary healthcare workers to both deliver high quality care, but also contribute to systems level trust and the associated improved population outcomes. While individual relationships may not be scalable, the factors that contribute to their success – background and understanding of the patient, accessibility, continuity of care, for example – can be. Supporting in primary care healthcare systems with the tools needed to emulate personalised care can improve trust, and the many related outcomes and experiences, for people living with chronic health conditions.
Time is a high-cost resource in primary care and time between patients and professionals is crucial to enhancing communication and building trust. As discussed in Section 6.3, when patients feel like they don’t have enough time with their care professional, trust in the healthcare system and professional also deteriorate. However, this outcome likely relates to more than just the length of appointments – despite the evident relationship between scheduled appointment times and trust. Having enough time with a care professional may have more to do with an appointment providing high quality care, getting the information, providing time to raise concerns, and not wasting time on providing information that professionals should already have in their systems – experiences that are all also significantly related to trust.
Patient-professional communication can be done more effectively, including clear explanations, transparency about treatment options, and how to handle misinformation that may affect trust – without necessarily requiring longer appointments. Other mechanisms for increasing efficiency and access, such as shared patient pools and virtual care, can be just as trustworthy as solo practices or face‑to-face care.
6.7.2. Supporting patients’ abilities to self-manage is a lever for improving trust in professionals and the system more broadly
Supporting patients’ abilities to self-manage their health can significantly increase their confidence in the healthcare system. This is particularly important for people living with chronic health conditions, where effective self-management can improve outcomes and reduce the need for costly and unnecessary health services. When patients are equipped with the knowledge, tools, and resources to manage their conditions effectively, it can result in feelings of empowerment and control of health outcomes. PaRIS survey participants with higher confidence in self-management also routinely report higher levels of trust in healthcare systems, reflecting recognition of the system’s role in providing the support for their self-management.
Educational programmes, digital health tools and supports, and consistent communication with care professionals are all critical components for advancing self-management confidence and capacity for people living with chronic conditions. Finally, organisational culture in primary care is key, as patients need to feel safe to raise concerns.
Trust, built over time between a care professional and patient, can create the space for dialogue and conversation that can help prevent patient safety incidents and miscommunication, while informing effective care that meets patients’ needs. As patients become more competent in managing their health, their positive experiences and outcomes reinforce their confidence in the broader healthcare system’s capability to deliver quality care and support, enhancing individual patient experience.
6.7.3. Improvements in communication and digital functionalities in the primary care are essential building blocks
Effective communication and enhanced digital functionalities are essential for advancing care co‑ordination within healthcare systems. As noted in Section 6.3, survey respondents who had to repeat health information that should have been documented in their care record were 32% less likely to trust the health system overall and 31% less likely to trust their healthcare professional. Ensuring that digital systems are interoperable across settings is essential to ensure care professionals can access important patient information, reducing the need for patients to repeatedly provide information, and subsequently improve care and minimise errors. Expanding digital tools like electronic health records, telemedicine, and patient portals can facilitate collaboration among healthcare professionals and improves patient access to health information. However, while these tools are necessary, this analysis shows that they are not sufficient alone to build trust; they must be implemented in ways that genuinely improve care outcomes – such as reducing adverse events, supporting continuity of care, and enabling more face‑to-face time with professionals.
For digital advancements to succeed, patients must feel confident that their data is securely managed and used only for legitimate purposes. Trust in the health system extends beyond individual care decisions and relies on transparent communication regarding public health decisions and healthcare policies. Finally, to build trust, digital health tools must not only drive improvements but also be transparent and involve patients in their design. This approach helps patients understand how their data is used and enhances usability, contributing to trust and system effectiveness.
Individual relationships are foundational to trust, serving as the bedrock upon which broader confidence in healthcare systems are built. PaRIS data show that consistent, positive interactions via a single/central healthcare professional foster a sense of trust and reliability on an inter-personal level. In addition, these individual experiences of trust can significantly influence a patient’s perception of the entire healthcare system, shaping their overall trust in the healthcare system’s ability to deliver quality care.
This spillover effect highlights the critical role that personal interactions play in enhancing the credibility and reliability of healthcare institutions, ultimately leading to a more trusting and resilient healthcare environment. Trust, like other essential aspect of healthcare system infrastructure, needs to be invested in, built, and maintained. Healthcare systems and policy makers play a crucial role in fostering trust among individuals with chronic health conditions by ensuring transparent communication and accessible, patient-centred care.
References
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← 1. See box What is trust? for more information on comparability.
← 2. The spread of false and misleading information (misinformation), often deliberately disseminated to deceive or mislead (disinformation), blurs public debates and fuels polarisation.
← 4. The indicator measures “Mental health” based on a person’s response to four questions on quality of life, emotional distress and social health, using the PROMIS Global Scale. The charts here show the scale score for an “average” person with specified characteristics, notably if they do or do not have chronic conditions, and by their primary healthcare professional. This score is a T-score metric in which 50 is the mean and 10 the standard deviation of the PROMIS reference population, and 40 is the cutoff for being in “good” mental health or better (as compared to “fair” health or worse).
← 5. Based on PaRIS item for last consultation, “Was the time you waited a problem for you?”.
← 6. There is a statistically significant difference between these two groups.
← 7. This analysis is conducted using a random intercept model. Please see Section 7.7.7 (model (1.) (equation 1.)) for technical details.